ANNUAL REPORT 2011-12
I.DARPANA- Transparency and Accountability Project
A) Expenditure Tracking- Supply of Drugs to PHCs & Evidence Based Advocacy.
IDPMS continued its’ effort in field based public expenditure tracking studies on public
health (drug supply). During the period under review effort was put on community based
advocacy work- mobilizing the PHC users and local GP members, sharing the outcome of our
studies on absenteeism and medicine stock out, training the selected people in community
monitoring of doctors’ absenteeism and medicine stock out etc. Drug Action Forum in 4
selected PHC areas were formed involving about 15-20 members each. Series of field
trainings are planned for these forums.
Pilot Project of crowd sourcing was launched in Chitradurga involving local NGO. Measuring
the absenteeism of doctor and other medical staff through SMS was taught to them.
1. Main Findings regarding medicines from Sampled PHCs are as followsIt was found from the analysis that stock out period is less than a month, and patients not
receiving the drugs ranges between 10-12%. However, when we probed with medical
officers, the scenario is little different. Given the fixed amount of one lakh rupee allocation
for drugs for each PHC, medical officers indent for low value, essential drugs such that those
drugs last for longer time.
Under prescription is commonly practiced to minimize the stock out period. Even though,
there is a demand for some of the high value essential drugs like nebulization solutions,
pediatric drops, catgut [suturing in tubectomy purpose], haemtonic syrum, doctors do not
indent them as they get less quantity of medicines and there will not be money for low
value, frequently used drugs. Also, there is a shortage of disposable syringes in PHCs. In such
cases, the doctors are compelled to ask the patients to buy them from private drug stores.
With the current drugs accounting method, we could only find out the inflow and outflow of
the medicines every month. Data regarding the number of patients with particular
ailment(s) and medicines supplied are not available. In such scenario, the true picture of the
type of medicines which are in short supply cannot be found as against the demand.
Under the present system as explained by the pharmacists, availability of drugs is enquired
orally with the drug ware house -- through telephone [hardly there is any written
correspondence]. Although, the inward/outward transaction would provide the details of
received drugs from the warehouses, this method of knowing the status of drugs would not
enable us to really identify the drug stock out period because of the fact that it does not
record the real demand for a particular drug at the PHC.
No procedure of maintaining the closing and opening balance of the stock [year on Year] at
the PHC level. Although, this has not affected the functioning of the PHC in its day-to-day
activity, yet this would be very important from the point of accountability.
Presently a typical PHC receives drugs not only from State – which is supplied through State
Drug ware house society but also separately from other various centrally sponsored
programme such as RCH, KIT-A, KIT-B etc. Apart from these, a PHC would receive drug from
Taluk Health Office (THO). It should be noted here that RCH – which is a NRHM programme,
KIT-A and KIT-B are channelized through District Health Office. Hence, there is a
requirement of accounting system but also a single window clearance – in a sense all the
drugs supplied to PHCs from various sources should be channelized from one window – it
could be the district ware house.
2. Other Initiatives taken
The Director and Dy. Director met personally both the Health Secretary and Health
Commissioner and explained to them the outcome of the studies and presented them
copies of the study. Contacts have been well established with both of them. Good contact
has been established with the Joint Director of Health and Family Welfare. Similarly contacts
have been established with the Executive Director and Financial Consultant of State Health
Systems Resource Centre (SHSRC) and they are contemplating to initiate joint studies and
actions on issues related to health and human resources. Broadly it is contemplated to work
jointly under the banner of Drug Action Forum rather than as an NGO.
IDPMS sought collaboration from Vijayanagar Institute of Medical Sciences Bellary and a
local rural development college for field research studies. Four students are under block
placement in two villages in Bellary district.
Collaboration with Janarogya Andolana for training and capacity building of Drug Action
Forum member and conducting joint field advocacy actions was done
Orientation for the field staff was done on evidenced based field advocacy
4. Setting up a panel of consultants and advisors.
One of the major impediments faced was absence of quality staff. This issue has been solved
by empanelling consultants for statistical analysis, field research, advocacy, community
mobilization, training, networking etc. Six consultants have been hired for execution of the
projects.
5. Formation of Advocacy Core Team
In order to make the process community based, steps have been initiated to form an
Advocacy core team consisting of IDPMS senior staff, consultants, two active volunteers
each from four Drug Action Forums. This team will be responsible for planning and
execution and review of all advocacy activities. This team will be provided organization
development and advocacy training. The team will meet every month to review and
planning.
6. Next Phase of IBP Project:
Based on the first two years of work, IBP asked a separate proposal for another one year.
Major focus of this phase is building field and community based advocacy strategies and
experiencing impacts. A detailed discussion was held with Dr Ravi Duggal Programme Officer
of IBP. A planning matrix was prepared.
Five project impacts envisaged are as followsEmpowered community improved oversight.
Use of technology improved response by policy makers
Budget becomes evidence based
Active civil society engagement in drug budgeting
Procurement transparency influence institutional reform and improve better budget
allocation.
7. Major Outcomes of the actions taken during the past six months.
With the formation of Drug Action Forum, good rapport and involvement of Gram
panchayat members has been established. They are actively participating in the field
actions. Good contact and participation of community has taken place. From Four Drug
Action Forum more than 100 volunteers from the four villages have come forward to
participate. Involvement of Anganawadi workers, village SHGs, youth clubs, village opinion
makers, PHC medical staff is taking place. Advocacy process has been institutionalized. An
advocacy core team will be established very soon. A core team of consultants to support the
project has been established Good contact has been established with the District Health
Office, Health Secretary and Health Commissioner. Absenteeism study was published An
advocacy film on Absenteeism was shot by an American team Pilot project on Crowd
Sourcing in 30 PHCs was done in Chitradurga district with the help of a local NGO. Advocacy
documentation and materials have been prepared. A field level research study was done in
two villages. This will help in the process of formation of participatory village drug budget.
8. Crowd sourcing project
The pilot project done in Chitradurga has given us encouragement to expand it to more
PHCs and districts. Our discussion with Bill Gates Foundation is continuing. They have again
requested us to send us our proposal and documentation. We need to contact Sir Ratan
Tata Trust again. Contact with mobile operators like Vodafone, Airtel or Idea should be
explored for getting sponsors. Health Commissioner and Health Secretary have shown
interest in this project. Initial responses and outcomes are promising. This will be expanded
to drug and will be formally launched in next 3-4 months time. Initial results on absenteeism
at Chitradurga PHCs can be seen at. http/:ushahidi.idpms.org
B) DUALITY OF APPROACHES BY THE PRIS AND HEALTH DEPARTMENT AT THE DISTRICT
LEVEL SUPPORTED BY PLANNING COMMISSION, GOI
Planning Commission GoI has awarded a small study for conducting field research to
understand and analyse the duality of approaches of PRIs and health department and its
impact on delivery of health services. The cost of this assignment is Rs.7.39 lakhs. The
questionnaire prepared was approved by the Planning Commission. There has been a little
delay in execution of this project. A draft report will be submitted to the Planning
Commission in May.
II.PROJECT MANINI (MAHILA NIRANTARA NIDHI)
Two Souharda women cooperatives- namely one in Kottur and other in Bellatti are
continuing their activities without much of IDPMS intervention. Besides, IDPMS do have
about 600 SHGs across 3 districts. Majority of the groups have yet to get accesses to credit.
In order to empower these groups, and meet their credit needs, NABFINS (A subsidiary of
NABARD started to give access to credit to SHGS in Southern states excluding AP) was
contacted. IDPMS will apply for NABFINS as a banking correspondent (BC) and it is proposed
to link around 500 women self help groups. This also could be a source of revenue
generation by way of commission from NABFINS.
III.PROJECT AARAMBH (RURAL LIVELIHOODS: ARTISAN CLUSTER)
A rural artisan cluster is promoted at Kuderumole (Chamarajanagar district) with the
support from Development Commissioner Handicrafts Government of India. It is important
to make this an independent surplus generating entity. Capacity building programme for the
cluster members was given. Orientation has been given to them to invest in the association
for business activities. A raw material demand survey was done. According to the survey,
the artisans need around 24 tonnes of raw material per month. Based on the outcome of
the discussion with Ms Hyma, IDPMS intends to take the role of an entrepreneur with the full
knowledge and understanding of the artisans. A raw material bank will be started.
IV.PROJECT BELAKU
Though most of the villages in Karnataka are provided electricity connection, the quality of
power supply is very poor and irregular. Village community need alternate energy supply for
their living. About two years ago IDPMS started on a pilot scale, distribution of LED batteries in
rural areas as an alternative energy source. The response was good. IDPMS has taken initial
steps to promote sales and distribution of the LED batteries through unemployed youths and
women groups in selected villages and towns in Bellary districts. Two unemployed boys with
electrical and electronic background are identified and they will be sent to THRIVE, Hyderabad
for training in repairs and maintenance. Besides, negotiations are in the process with village
community and panchayats to install solar/LED street lights. In the coming months, it is
proposed to start rural energy kiosks.
V.SUPPLY OF FLUORIDE FREE DRINKING WATER IN RURAL AREAS.
While working on our health projects in Gadag and Bellary districts, it was observed that
most of the villagers complained of severe joint pains, distorted teeth and deformed legs
and hands. The reason was underground water in most of the districts in northern districts
have high content of fluoride causing fluorisis. Initiatives of the state government are
lukewarm and met with hardly any success. Local panchayats and citizens are willing to go
for their system of supplying fluoride free water. We have done initial technical analysis of
different models, cost of machinery, installation and maintenance. We are in discussion with
one panchayat at Korlgundi village, Bellary district. The village community and panchayat
have come forward to set up a village based system. If this is materialized, more villages are
willing to have their own systems. IDPMS will be responsible for maintenance of the system
and training community leaders in operation and maintenance work and fixing water
charges.
VI.MEDICINE KIOSK
During our work with community, we found that major out of pocket expenses of outpatient
was towards purchase of medicines. Often they do not have access. There is a huge demand
for the same and in this direction; IDPMS is looking at setting up of Medicine Kiosks at
village itself. IDPMS is discussing with technology experts, doctors and medicine suppliers to
set up a village based drug shop on a community franchise model. Besides, simple diagnostic
tests and medical facility will be provided for a small fee. Details have to be worked out.
VII.GOVERNMENT SUPPORTED PROGRAMMES.
A. Target Intervention project for FSWs and MSMs in Chamarajanagar district supported
by KASAPS
The project has been extended for a period of two years. We have received a draft budget
of Rs.38 lakhs. Project Officer informed that this is a two year project and is expected to
come to an end by March 2014. The project has a separate team and a project office is
located at Chamarajanagar district. The project is directly monitored by KASAPS and the
project has been meeting the targets set by KASAPS. B.Consultancy for Minor irrigation
project department Final report was submitted and all the pending formalities completed.
The balance amount is due for the organization from Minor irrigation department.
VIII.FINANCIAL PROGRESS FOR THE PERIOD OCTOBER 2011-MARCH 2012
During this period, a short term field study was done for CBPS. IBP released the first installment
of the second phase of the project. KASAPS released the final installment for the year 20112012. Rs. 26.60 lakhs were received during this period. Due to number of field activities, field
expenditure has also increased. During this period, receipts have increased as compared to the
first six months.